Is GreenLight right for you?

GreenLight laser is one of several transurethral options for an enlarged prostate. It is not the right operation for every man. The factors below are what Dr Kooner uses to decide, alongside your preferences.

GreenLight is usually a good fit if...

  • Your prostate is in the small-to-medium size range. GreenLight is most commonly used for prostates up to about 80 cc, although it can be used in larger glands with longer operating time.
  • You are on an anticoagulant medication that cannot easily be paused. Published series report acceptable safety for GreenLight in men on oral anticoagulants.2
  • You would prefer a shorter operation with a good chance of same-day or next-morning discharge.
  • Your symptom pattern is typical bladder outlet obstruction from BPH rather than a neurogenic or bladder-side problem.

GreenLight is less suited if...

  • Your prostate is very large (generally above 100 cc), where HoLEP is usually preferred for durability and complete removal.4
  • There is a strong suspicion of prostate cancer and you have not had a recent targeted biopsy, because GreenLight does not produce a specimen for pathology.
  • You have very severe bladder dysfunction that is not simply outlet obstruction.
  • The main goal is the lowest possible long-term retreatment rate, where HoLEP has advantages over longer follow-up.4

Work-up before deciding

  • IPSS (International Prostate Symptom Score) and quality-of-life score.
  • Urine flow rate and post-void residual.
  • Urinalysis and MSU.
  • PSA where clinically appropriate.
  • Prostate size on ultrasound or MRI.
  • Flexible cystoscopy where the anatomy is uncertain.
  • A full list of current medications, especially anticoagulants.

How GreenLight compares with the five main alternatives

A simplified side-by-side to help with a conversation. Every row in the table is a generalisation and your individual case may differ.

Factor GreenLight HoLEP TURP UroLift Rezum iTind
What it does Vaporises tissue with a 532 nm laser Enucleates tissue with a Holmium laser Cuts tissue with a heated wire loop Mechanical implants hold tissue aside Steam injected into prostate tissue Temporary nitinol device reshapes urethra
Best prostate size Small to medium (up to around 80 cc) Any size, including very large Small to medium Small to medium, no middle lobe Small to medium Small to medium
Tissue removed Yes, by vaporisation (no specimen) Yes, morcellated specimen Yes, cut into strips No No (reabsorbed over weeks) No
Anaesthetic General or spinal General or spinal General or spinal Local or light sedation Light sedation Light sedation
Bleeding risk Low; suitable for many men on anticoagulants2 Low Moderate (higher than laser options) Very low Very low Very low
Usual hospital stay Day surgery or one night One night One to two nights Day surgery Day surgery Day surgery (device removed later)
Long-term retreatment Higher than HoLEP in published series4 Lowest of the group Intermediate Higher than HoLEP Higher than HoLEP Higher than HoLEP
Sexual function Retrograde ejaculation common; erectile function usually preserved Retrograde ejaculation common; erectile function usually preserved Retrograde ejaculation common Ejaculation usually preserved Ejaculation usually preserved Ejaculation usually preserved
How Dr Kooner uses this. No single operation is best for everyone. GreenLight is usually picked when the priorities are a short operation, good bleeding control and a smaller prostate. HoLEP is usually picked when the priorities are a very large prostate, the lowest retreatment rate or the need for a histology specimen.

Request a second opinion Read about alternatives

Considering GreenLight laser for an enlarged prostate?

Ask for a second opinion on your symptom score, flow studies and prostate size before committing to a treatment plan.

Request a second opinion Call 02 8382 6980